Nursing 471 A & P, Care for Pregnancy Dr. Jeannie Harper, PhD, RN
Uterus and Cervix Prepregnancy weight grams Term weight grams Out of true pelvis at 12 weeks At level of umbilicus at ~22 wks Rotates to right side Uterus, isthmus and cervix soften Uterine souffle arterial flow to placenta
Uterus and Cervix Funic souffle blood flowing through umbilical cord Chadwick’s sign bluish discoloration of cervix Goodell’s sign softening of cervical tip Hegar’s sign softening of lower uterine segment
Uterus and Cervix Ballottement ~ wks Quickening Multigravida weeks Primagravida 20 weeks Leukorrhea
Breasts Tender, tingling, fuller, heavier Nipples pigmented Montgomery’s tubercles Colostrum present at 16 weeks
Cardiovascular System Heart rate increases Cardiac output increases Blood volume increases by 40-50% RBC mass increases by 17% H and H decreases WBC count increases 2 nd and 3 rd trimester Clotting factors increase
Respiratory System Rate- no change or slight rise Total lung capacity-no change or slight decrease Oxygen consumption increases by 15-20%
Basal Metabolic Rate Varies Increases 15-20% at term
Renal System Renal pelvis and ureters dilate R side more affected Bladder capacity increases to 1500 mls r/t decreased bladder tone Urinary frequency and urgency 1 st and 3 rd trimesters
Renal System GFR and RPF increase Mild glucosuria in 20% of pregnant women Mild proteinura may be present Increased tubular reabsorption
Integumentary System Hyperpigmentation Chloasma Striae gravidarum Linea nigra Angiomas
Integumentary System Palmar erythema Pruritis Epulis Acne, oily skin
Musculoskeltal System Lordosis Waddling Pelvic joint relaxation Diastasis recti abdominus
Neurologic System Carpal tunnel syndrome Numbness/tingling of hands Lightheadness and syncope in early pregnancy
Gastrointestinal System Appetite fluctuates Morning sickness 1 st trimester Peristaltic activity decreases Taste changes Craving Hemorrhoids Hypertrophy of gums Ptyalism Pyrosis
Endocrine System HCG maintains corpus luteum Hormone levels increase Estrogen Progesterone Prolactin Relaxin Hormones decrease maternal ability to use insulin Estrogen Progesterone HCS/HPL Cortisol
Diagnosis of Pregnancy Subjective Symptoms Presumptive Objective Signs Presumptive Diagnostic Positive
Care of Pregnant Woman Initial Visit Interview Obstetric & current pregnancy history Medical and nutritional history Family and social history Height, Weight, FHR Physical Exam Laboratory Tests CBC, Bl type, Rh, VDRL/RPR, TB, HPV GBS, HIV, GC, Chlamydia, Hep B, Toxo Sickle cell, Pap Smear
Initial Visit (cont’d) Gestational age EDC, EDD, EDB Noninvasive methods LMP date (Nagele’s Rule) Quickening date Fundal height measurement Invasive methods FHR by Doppler Ultrasongraphy
Care of Pregnant Woman Subsequent Visits Monthly 1 st and 2 nd trimesters Every two weeks from week 28 Every week from week 36 Weight, BP, urinalysis FHR, fetal movement, fundal hgt 1-hr GTT 1 st visit risk, 28 wks 28wks, 37 wks
Education Discomforts of pregnancy Signs of potential complications Recognizing preterm labor Physical activity/exercise Body mechanics
Education Employment Rest and relaxation Dental care Medications Substance abuse
Education Safety Travel Sexual counseling Nutrition
Quality versus Quantity Do not diet Fluid requirements 6-8 glasses per day Protein and iron critical Pica
Nutrition Additional caloric requirements Pregnancy 300 in 2 nd and 3 rd trimesters Lactation 500 calories
Weight Gain Based on Body Mass Index (BMI) Normal BMI11.5 – 16 kgs Underweight BMI12.5 – 18 kgs Overweight BMI7 – 11.5 kgs Obese BMIAt least 7 kgs Teens11.5 – 16 kgs
Adaptation to Pregnancy Maternal Accepting pregnancy Identifying with role of mother Reordering relationships Establishing relationship with unborn child Preparing for childbirth
Adaptation to Pregnancy Paternal Announcement phase Moratorium phase Focusing phase Couvade Sibling
Special Pregnancy Care Cultural considerations Childbirth education Teen pregnancy